Establishing an MSU service in a medium-sized German urban area — clinical and economic considerations

Rink, Johann ; Tollens, Fabian ; Tschalzev, Andrej ; Bartelt, Christian ; Heinzl, Armin ; Hoffmann, Jens ; Schoenberg, Stefan O. ; Marzina, Annika ; Sandikci, Vesile ; Wiegand, Carla ; Hoyer, Carolin ; Szabo, Kristina

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URN: urn:nbn:de:bsz:180-madoc-668249
Document Type: Article
Year of publication Online: 2024
Date: 29 February 2024
The title of a journal, publication series: Frontiers in Neurolgy
Volume: 15
Issue number: 1358145
Page range: 1-9
Place of publication: Lausanne
Publishing house: Frontiers Research Foundation
Publication language: English
Institution: Business School > ABWL u. Wirtschaftsinformatik I (Heinzl 2002-)
Außerfakultäre Einrichtungen > Institut für Enterprise Systems (InES)
Pre-existing license: Creative Commons Attribution 4.0 International (CC BY 4.0)
Subject: 610 Medicine and health
Keywords (English): acute stroke care , mobile stroke units , prehospital stroke care , computerized tomography , prehospital thrombolysis
Abstract: Background and purpose: Mobile stroke units (MSU) have been demonstrated to improve prehospital stroke care in metropolitan and rural regions. Due to geographical, social and structural idiosyncrasies of the German city of Mannheim, concepts of established MSU services are not directly applicable to the Mannheim initiative. The aim of the present analysis was to identify major determinants that need to be considered when initially setting up a local MSU service. Methods: Local stroke statistics from 2015 to 2021 were analyzed and circadian distribution of strokes and local incidence rates were calculated. MSU patient numbers and total program costs were estimated for varying operating modes, daytime coverage models, staffing configurations which included several resource sharing models with the hospital. Additional case-number simulations for expanded catchment areas were performed. Results: Median time of symptom onset of ischemic stroke patients was 1:00 p.m. 54.3% of all stroke patients were admitted during a 10-h time window on weekdays. Assuming that MSU is able to reach 53% of stroke patients, the average expected number of ischemic stroke patients admitted to MSU would be 0.64 in a 10-h shift each day, which could potentially be increased by expanding the MSU catchment area. Total estimated MSU costs amounted to € 815,087 per annum. Teleneurological assessment reduced overall costs by 11.7%. Conclusion: This analysis provides a framework of determinants and considerations to be addressed during the design process of a novel MSU program in order to balance stroke care improvements with the sustainable use of scarce resources.
Additional information: Verfasser hier: Johann S. Rink

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